Alternatives to Synthetic Midurethral Slings in the Surgical Management of Female Stress Urinary Incontinence: Results of a National Survey.

INTRODUCTION AND HYPOTHESIS: The midurethral sling (MUS) is the surgical reference treatment for female stress urinary incontinence (SUI). Concerns regarding MUS safety have led to their authorization in France being questioned. A survey was conducted to investigate alternatives to MUS.

METHODS

An online questionnaire was distributed via three scientific societies. It explored the characteristics of the respondents, their experience with MUS, and alternatives.

RESULTS

A total of 173 practitioners responded to the survey: 85% were gynecologists and 15% urologists. Nearly 70% had more than 10 years of experience, and 39% reported dedicating more than half of their activity to urogynecology. The use of MUS remained predominant: 65% regularly performed transobturator tape, and 61% tension-free vaginal tape procedures. Among surgical alternatives, 52% of practitioners had never performed a Bulkamid® injection. Among users, half performed fewer than 10 procedures per year. Over 90% considered this procedure less effective, but also less risky than MUS in the long term. Colposuspension had never been performed by 46% of respondents. Among those who had performed it, 20% performed between 1 and 5 per year, and 73% no longer performed it. It was considered less effective by 71% of respondents, and less prone to complications by 45%. Finally, 73% of practitioners had never performed an autologous sling. It was perceived as less effective by 68% of respondents, and less risky than MUS by 44%.

CONCLUSION

This survey highlights the current fragility of surgical alternatives in the management of female SUI among French urologists and gynecologists.